Presentation given to outline an ongoing research study which is evaluating “The Nike+ Fuelband as a motivational tool to encourage adherence to exercise prescription for the teenager with congenital heart disease”.

1. HYPOTHESIS:
The Nike+ FuelBand is a motivational tool for
exercise prescription in the teenager with congenital
heart disease
Dr AG Stuart, Cardiologist Sports Cardiology UK

2. EXERCISE & SPORT
“ Exercise is bunk. If you are
healthy, you don’t need it,
if you are sick, you shouldn’t
take it. ”
Henry Ford

3. EXERCISE & SPORT
“ If we could give every
individual the right amount of
nourishment and exercise, not
too little and not too much, we
would have found the safest
way to health. ”
Regimen (Book 1)
Hippocrates
460-370 BC

4. REGULAR EXERCISE
Regular exercise
Incidence
General health benefits
• Diabetes mellitus
• Lipid profile
• Colon cancer
• Osteoporosis
• Anxiety / depression
• Dementia
• Hypertension

5. Specific benefits in heart disease
“Exercise is one of the cheapest- and most effective- interventions for reducing the morbidity and mortality of
cardiovascular disease.”
Booth J Appl Physiol 2000;88:774-787
AHA Scientific Statement April 2013
Promotion of Physical Activity in Children and Adults with Congenital Heart Disease
Longmuir et al Circulation 2013 DOI:10.1161/CIR.0b013e318293688F
“Most patients with congenital heart defects are relatively sedentary”
“counselling to encourage daily participation in appropriate physical activity should be a core component of every
patient encounter….”
REGULAR EXERCISE

6. HOW DOES
EXERCISE HELP?

7. Q: HOW DOES EXERCISE HELP?
• Improving endothelial function
• Improving cardiac function
• Improving skeletal muscle function
A: MULTIFACTORIAL

8. HEART FAILURE AND EXERCISE
“Chronic heart failure is associated with skeletal muscle abnormalities which cause fatigue / lactic acidosis”
Hambrecht et al JACC 1997;29:1067-73
Muscle biopsy
41% increase in mitochondrial density,
shift from type 11 to type 1 fibres
Exercise tests
femoral venous lactate related to
mitochondrial density not leg blood flow
Regular physical exercise increased oxidative enzyme activity in skeletal muscle
vs inactive controls6 months exercise training
(18 patients)

9. WHY IS EXERCISE
PRESCRIPTION
NOT USED?

10. Q: WHY IS EXERCISE
PRESCRIPTION NOT USED?
A1: MOST CARDIOLOGISTS DO
NOT KNOW HOW TO PRESCRIBE
EXERCISE*
*Swan 2000, Lewin 2002

11. < 20% patients given exercise advice (Swan, 2000)
< 20% units had exercise program (Lewin, 2002)
A1: MOST CARDIOLOGISTS DO
NOT KNOW HOW TO PRESCRIBE
EXERCISE*
*Swan 2000, Lewin 2002

12. Q: WHY IS EXERCISE
PRESCRIPTION NOT USED?
A2: MOST EXERCISE
PRESCRIPTIONS ARE INEFFECTIVE
IN TEENAGERS**
**Metcalf 2012

13. Physical activity interventions have only a small effect in
children’s overall activity levels. Approx 4 mins walking /
running per day. (Metcalf 2012)
A2: MOST EXERCISE
PRESCRIPTIONS ARE
INEFFECTIVE IN TEENAGERS**
**Metcalf 2012

14. TEENAGERS DON’T
LIKE BEING TOLD
WHAT TO DO...

15. GAMIFICATION
“The use of game thinking and game mechanics in
a non-game context to engage users and solve
problems. Used to improve user engagement.”*
* Marczwski 2012

16. THE NIKE+ FUELBAND
• 3 axis wrist worn accelerometer
• 3 sizes / 2 colours
• Set up using
• Links to mobile phone / computer
• Output :
• calories
• Nike Fuel Points
• steps

17. THE NIKE+ FUELBAND
1.Setup (age / height / weight)

18. THE NIKE+ FUELBAND
1.Setup (age / height / weight)
2.Set Goal (say 2,000 points?)

19. THE NIKE+ FUELBAND
1.Setup (age / height / weight)
2.Set Goal (say 2,000 points?)
3.Join Nike+

20. THE NIKE+ FUELBAND
1.Setup (age / height / weight)
2.Set Goal (say 2,000 points?)
3.Join Nike+
4.Sync (phone / computer)

21. THE NIKE+ FUELBAND

22. CHARTS OF PROGRESS

23. REWARDS & SOCIAL CAPITAL

24. Exercise prescription in the teenager with congenital heart disease
THE STUDY
Q1: DOES THE USE OF THE NIKE
FUELBAND INCREASE PHYSICAL ACTIVITY
IN THE STUDY GROUP?

25. THE STUDY
Q2: DO ‘FUEL POINTS’ CORRELATE WITH
MEASUREMENTS OF PHYSICAL ACTIVITY
USING A CONVENTIONAL UNIAXIAL
ACCELEROMETER?
Q1: DOES THE USE OF THE NIKE
FUELBAND INCREASE PHYSICAL ACTIVITY
IN THE STUDY GROUP?
Exercise prescription in the teenager with congenital heart disease

26. • Prospective, intervention study
• Adolescents attending BCHC
• Identified Heartsuite database
• Consent obtained via routine OP review
• n =30 ; 13-18yrs old
• All requiring long term follow up
• Exclusions: learning disability / lack of computer access /
recent surgical intervention (<6 months)
Exercise prescription in the teenager with congenital heart disease
THE STUDY

27. • Prospective, intervention study
• 3 symptom categories
• asymptomatic / NYHA 2 / NYHA 3 or 4
• 3 measures of activity
• Actigraph
• FuelBand
• Non weartime diary
Exercise prescription in the teenager with congenital heart disease
THE STUDY

28. MEASURES OF ACTIVITY
Actigraph 7164
•“Hip worn”
•7 day activity counts
•10hrs for 4 days minimum
Nike FuelBand Non-weartime diary
•“Wrist worn”
•Daily activity counts
•Gamified & social aspects
•Enables capture of activity
when no accelerometer is
being worn
Exercise prescription in the teenager with congenital heart disease

29. • Recruitment
Exercise prescription in the teenager with congenital heart disease
• Consent
• Haemodynamic and clinical
assessment
• Advised to exercise “as much
as possible” up to 60 mins /
day
PRE LAUNCH
STUDY SCHEDULE

30. • Recruitment
• Baseline assessment
Exercise prescription in the teenager with congenital heart disease
• Actigraph issued
• Wear 7 days (not water!)
• Record diary
• Calculate Fuelpoints (target
750/1500/2500)
WEEK 1
STUDY SCHEDULE

31. • Recruitment
• Baseline assessment
• FuelBand intervention
Exercise prescription in the teenager with congenital heart disease
• FuelBand issued
• Points prescribed
• Link to study Facebook &
Twitter
WEEK 2 - 9
STUDY SCHEDULE

32. • Recruitment
• Baseline assessment
• FuelBand intervention
• Reassesssment
Exercise prescription in the teenager with congenital heart disease
• Actigraph issued
• FuelBand used
• Comparison actigraph/
Fuelband
WEEK 10
STUDY SCHEDULE

33. • Recruitment
• Baseline assessment
• FuelBand intervention
• Reassessment
• Data Analysis
Exercise prescription in the teenager with congenital heart disease
• Actisoft software v3.2
• Total FuelBand point/week
• Statistical tests
WEEK 10
Repeated measures ANOVA between groups at baseline and
follow-up. Paired T tests for assessment of change in PA
between baseline and Fuelband intervention stage. Bland
Altman used to correlate levels of physical activity between
FuelBand and Actigraph.
STUDY SCHEDULE

34. EXPECTED RESULTS AND
ANTICIPATED VALUE OF STUDY
Anticipated significant increase in activity associated
with FuelBand intervention. This will enable self and
peer motivation of exercise participation. Potential for
significant health benefit, self efficacy and
development of “exercise habit”.

35. LIMITATIONS OF STUDY
Requirement to use expensive device and need for
internet and computer/smartphone access and
competent IT skills. Social media use may not be
acceptable in younger patients. Benefit may be time
limited. Hand based exercise only assessed.
Funding identified ( GUCH Research Fund).
Study adopted by UHBristol (4 months delay).
Submitted for IRAS and ethics approval – awaited.

36. FINAL HYPOTHESIS:
The Nike+ FuelBand is a motivational tool for
exercise prescription in the teenager with congenital
heart disease